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UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP OF SECURITIES Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934, Section 17(a) of the Public Utility Holding Company Act of 1935 or Section 30(h) of the Investment Company Act of 1940 |
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Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. | |||
Persons who respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB control number. | SEC 1474 (9-02) |
1. Title of Derivative Security (Instr. 3) |
2. Conversion or Exercise Price of Derivative Security | 3. Transaction Date (Month/Day/Year) | 3A. Deemed Execution Date, if any (Month/Day/Year) | 4. Transaction Code (Instr. 8) |
5. Number of Derivative Securities Acquired (A) or Disposed of (D) (Instr. 3, 4, and 5) |
6. Date Exercisable and Expiration Date (Month/Day/Year) |
7. Title and Amount of Underlying Securities (Instr. 3 and 4) |
8. Price of Derivative Security (Instr. 5) |
9. Number of Derivative Securities Beneficially Owned Following Reported Transaction(s) (Instr. 4) |
10. Ownership Form of Derivative Security: Direct (D) or Indirect (I) (Instr. 4) |
11. Nature of Indirect Beneficial Ownership (Instr. 4) |
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Code | V | (A) | (D) | Date Exercisable | Expiration Date | Title | Amount or Number of Shares | ||||||||
Series B Preferred Stock | (1) | 05/28/2013 | C | 42,260 | (1) | (5) | Common Stock | 42,260 | $ 0 | 0 | I | Alta BioPharma Partners III GmbH & Co. Beteiligungs KG (4) | |||
Series B Preferred Stock | (1) | 05/28/2013 | C | 629,255 | (1) | (5) | Common Stock | 629,255 | $ 0 | 0 | I | Alta BioPharma Partners III, L.P. (4) | |||
Series B Preferred Stock | (1) | 05/28/2013 | C | 15,507 | (1) | (5) | Common Stock | 15,507 | $ 0 | 0 | I | Alta Embarcadero BioPharma Partners III, LLC (4) | |||
Series C Preferred Stock | (2) | 05/28/2013 | C | 28,255 | (2) | (5) | Common Stock | 28,255 | $ 0 | 0 | I | Alta BioPharma Partners III GmbH & Co. Beteiligungs KG (4) | |||
Series C Preferred Stock | (2) | 05/28/2013 | C | 420,738 | (2) | (5) | Common Stock | 420,738 | $ 0 | 0 | I | Alta BioPharma Partners III, L.P. (4) | |||
Series C Preferred Stock | (2) | 05/28/2013 | C | 10,368 | (2) | (5) | Common Stock | 10,368 | $ 0 | 0 | I | Alta Embarcadero BioPharma Partners III, LLC (4) | |||
Series D Preferred Stock | (3) | 05/28/2013 | C | 4,447 | (3) | (5) | Common Stock | 4,447 | $ 0 | 0 | I | Alta BioPharma Partners III GmbH & Co. Beteiligungs KG (4) | |||
Series D Preferred Stock | (3) | 05/28/2013 | C | 66,221 | (3) | (5) | Common Stock | 66,221 | $ 0 | 0 | I | Alta BioPharma Partners III, L.P. (4) | |||
Series D Preferred Stock | (3) | 05/28/2013 | C | 1,632 | (3) | (5) | Common Stock | 1,632 | $ 0 | 0 | I | Alta Embarcadero BioPharma Partners III, LLC (4) |
Reporting Owner Name / Address | Relationships | |||
Director | 10% Owner | Officer | Other | |
CHAMPSI FARAH ONE EMBARCADERO CENTER 37TH FLOOR SAN FRANCISCO, CA 94111 |
X |
/s/ Sally A. Kay, as attorney-in-fact | 05/28/2013 | |
**Signature of Reporting Person | Date |
* | If the form is filed by more than one reporting person, see Instruction 4(b)(v). |
** | Intentional misstatements or omissions of facts constitute Federal Criminal Violations. See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a). |
(1) | Upon the closing of the Issuer's initial public offering, each share of Series B Preferred Stock automatically converted into 1 share of Common Stock for no additional consideration and had no expiration date. |
(2) | Upon the closing of the Issuer's initial public offering, each share of Series C Preferred Stock automatically converted into 1 share of Common Stock for no additional consideration and had no expiration date. |
(3) | Upon the closing of the Issuer's initial public offering, each share of Series D Preferred Stock automatically converted into 1 share of Common Stock for no additional consideration and had no expiration date. |
(4) | Alta Partners III, Inc. provides investment advisory services to Alta BioPharma Partners III, L.P., Alta BioPharma Partners III GmbH & Co. Beteiligungs KG and Alta Embarcadero BioPharma Partners III, LLC (collectively, the Alta Funds). The directors of Alta BioPharma Management III, LLC, which is the general partner of Alta BioPharma Partners III, L.P., the managing limited partner of Alta BioPharma Partners III GmbH & Co. Beteiligungs KG, and the manager of Alta Embarcadero BioPharma Partners III, LLC, exercise sole dispositive and voting power over the securities owned by the Alta Funds. Farah Champsi, a director of Alta BioPharma Management III, LLC and a manager of Alta Embarcadero BioPharma Partners III, LLC may be deemed to beneficially own the securities, and disclaims beneficial ownership of the shares identified in this footnote except to the extent of her respective proportionate pecuniary interest in such shares. |
(5) | The shares do not have an expiration date. |